Provider Demographics
NPI:1376835892
Name:INTA, RINA (RD,LD)
Entity Type:Individual
Prefix:MRS
First Name:RINA
Middle Name:
Last Name:INTA
Suffix:
Gender:F
Credentials:RD,LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2653 AERO DR
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75052-7619
Mailing Address - Country:US
Mailing Address - Phone:682-561-7059
Mailing Address - Fax:888-419-5741
Practice Address - Street 1:2653 AERO DR
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75052-7619
Practice Address - Country:US
Practice Address - Phone:682-561-7059
Practice Address - Fax:888-419-5741
Is Sole Proprietor?:No
Enumeration Date:2011-05-03
Last Update Date:2012-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX133V00000X133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered